House leaders and President Trump press for ‘yes’ as they prepare to vote Friday on health-care reform – Washington Post

House leaders and President Trump pressed for “yes” votes from fellow Republicans as they prepared to vote Friday to overhaul the nation’s health-care system and deliver the central promise that brought them to power.

With a vote expected later in the day, lawmakers began considering the bill during a rare early-morning session of the panel that sets rules for House floor debate. At the same time, Trump and White House officials were confidently anticipating victory. A day after he had delivered an ultimatum to Republicans to approve the proposal or move on to other priorities, the president took to Twitter to try to close the deal.

Mulvaney was dispatched to the U.S. Capitol on Thursday to tell rank-and-file Republicans in a closed-door meeting that Trump was done negotiating with them.

It was a high-risk gamble for Trump and House Speaker Paul D. Ryan (R-Wis.), who have invested significant political capital trying to pass legislation that would replace the 2010 Affordable Care Act. For Trump, who campaigned as a skilled negotiator capable of forging a good deal on behalf of Americans, it could either vindicate or undercut one of his signature claims.

With 237 House Republicans, party leaders can afford only 21 or 22 defections, depending on how many Democrats are present on Friday. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation. An unsuccessful vote could also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.

No matter what happens in the House, the ultimate fate of the legislation hinges on the Senate. There are at least a dozen skeptics of the bill among Senate Republicans, who maintain a slim 52-to-48 advantage, and many of them want to maintain some of the current law’s more generous spending components.

Defeat of the legislation would mean that Obamacare — something that congressional Republicans have railed against for seven years — would remain in place.

House Speaker Paul D. Ryan (R-Wis.) walks to a meeting Thursday with the GOP about the American Health Care Act trying to drum up support along with Mick Mulvaney, President Trump’s director of the Office fo Management and Budget. (Katherine Frey/The Washington Post)

Republicans convened a Rules Committee hearing at the crack of dawn Friday, where they sought to sign off on the final changes they made to the bill the previous day. In a snug room near the House chamber, the meeting quickly turned into a tense partisan clash, as Democrats expressed their disgust with the measure and Republicans sought to defend their legislation.

“You never intended for there to be a health plan of consequence for this nation,” said Rep. Alcee Hastings (D-Fla.), raising his voice as he spoke.

He added: “What we will have done is helped rich people. And we will not have helped poor people.”

Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and one of the bill’s architects, forcefully rejected Hastings’s claim during testimony before the rules panel, saying he was “offended” by the remark. He tried tempering the tone of his exchange with Hastings, who wouldn’t oblige.

“I’m mad as hell about what you all are doing!” the Democrat exclaimed.

Republicans defended their last-minute tweaks, including the way the bill addresses essential-benefit requirements in the ACA.

Rep. Rob Woodall (R-Ga.) said the bill would affect millions of people. “And it is going to do so in a dramatically positive way,” he added.

It was still far from clear Friday morning whether GOP leaders have the votes to muscle the package through the House after several members of the hard-line House Freedom Caucus refused to back it following a marathon session of negotiations Thursday with Trump and other top aides.

In tweets Friday, Trump targeted the Freedom Caucus, saying, “The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!”

On Thursday night, Ryan refused to answer shouted questions from reporters after emerging from closed-door sessions about whether he had the votes for passage.

“They’re going to bring it up, pass or fail,” said Rep. Mike Simpson (R-Idaho) said after Thursday night’s closed-door meeting.

During that meeting, Mulvaney told his former colleagues “the president needs this, the president has said he wants a vote tomorrow up or down,” according to Rep. Chris Collins (R-N.Y.),

“If for any reason it’s down, we’re just going to move forward with additional parts of his agenda,” Collins described Mulvaney as saying. “This is our moment in time.”

A key moment inside the session, several lawmakers said, was when Rep. Brian Mast (R-Fla.), a freshman lawmaker who lost both his legs in 2010 while serving as an Army bomb disposal technician in Afghanistan, rose and called on his colleagues to unite behind the bill in the same way he and his comrades fought in battle.

A rowdy group of Republicans burst out of the meeting like explorers on a quest for glory. “Burn the ships,” one Republican shouted to House Majority Whip Steve Scalise (La.), invoking the command that Hernan Cortes, the Spanish conquistador, gave his men upon landing in Mexico in 1519.

The message was clear, to the GOP leaders now and the Spaniards in 1519, there was no turning back.

“Only way to do it,” Scalise told a packed elevator of lawmakers.

After the meeting, and during an unrelated late-night vote, Ryan got down on a knee to plead with Rep. Don Young, an 83-year-old from Alaska who is the longest-serving Republican in Congress and remains undecided.

When the speaker finished with Young, he spent about 10 minutes in an animated discussion with Rep. Mo Brooks (R-Ala.), one of the bill’s most outspoken critics. At one point, the speaker took his own arms and held them up, his hands at face level, then slowly lowered them to his waist — presumably trying to demonstrate his belief that the bill will lower costs.

The ongoing effort to whip the vote, Rep. Joe Barton (R-Tex.) said at one point, involved “back-patting and butt-kicking.”

“Democracy’s messy,” he added.

Ryan had intended to bring up his plan for a vote Thursday, but that plan unraveled after Freedom Caucus members rejected Trump’s offer to strip a key set of mandates from the nation’s current health-care law. White House Chief of Staff Reince Priebus and Trump chief strategist Stephen K. Bannon trooped up to Ryan’s office to make the case personally, warning recalcitrant conservatives that the only alternative would be to accept the ACA as the law of the land.

By evening, leaders adopted the proposed change conservatives had rebuffed earlier, eliminating the law’s “essential benefits” that insurers must offer under the ACA in an effort to reduce premium costs. Those benefits include covering mental-health treatment, wellness visits, and maternity and newborn care, and states would have the option of adding them back next year.

They also added one sweetener for moderates, a six-year delay in repealing a 0.9 percent additional Medicare tax on high-income Americans who earn above $200,000 if filing individually, or $250,000 if married and filing jointly. By keeping the tax in place, GOP leaders could provide an additional $15 billion to the states to help cover treatment for mental health and substance abuse issues, as well as maternity and infant care.

Meanwhile, a new analysis by the Congressional Budget Office released Thursday evening showed that changes House leaders made to the bill Monday do not alter a projection that 24 million more Americans would be uninsured by 2026 under the bill. In addition, the updated bill would cut the deficit by $150 billion over the next decade — nearly $200 billion less than the earlier version of the legislation.

The changes include a couple of conservative overhauls to the Medicaid program and language directing that $85 billion be used to help Americans ages 50 to 64 obtain coverage.

It was unclear how the new CBO score would affect legislative support for the bill.

But it was lawmakers on the right eager to dismantle the current health-care law who remained GOP leaders’ biggest problem.

“I’m still a ‘no’ on the bill,” said Rep. Mark Meadows (R-N.C.), who chairs the Freedom Caucus. “I think it’s the president leading, and I applaud him for leading.”

Some key moderates are also against the bill. Rep. Dan Donovan (R-N.Y.), who has known Trump for decades and whose Staten Island district swung heavily toward the Republican candidate, left the meeting committed to voting no.

“I’ve got to think about the 744,000 people I represent,” he said. Asked about the White House’s message that killing the bill would leave no more chances for repeal, he shook his head. “I don’t believe that.”